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Recently uploaded on WebSurg

Surgical intervention
Thoracoscopic thymectomy using a subxiphoid camera port
Thoracoscopic thymectomy is currently considered the approach of choice for the treatment of thymic conditions, including myasthenia gravis (MG). It has demonstrated advantages over open approaches, because it reduces postoperative pain, hospital stay, blood loss, promotes early patient discharge, and provides cosmetic improvement. The use of a subxiphoid access, either as a single port or camera-assistant port, grants even greater benefits as it allows the following: visualization of the phrenic nerve to the contralateral phrenic nerve, reaching all the thymus poles and the lower limit of the thyroid gland, peritracheal fat and aortopulmonary window, pericardial dissection and bilateral epiphrenic fat removal. In addition, it facilitates bilateral exploration through a pleural opening without the need to place another trocar on the left, and the use of carbon dioxide throughout the surgery, thereby avoiding sternal retraction. The dissection through the correct planes, and the systematization of the operative technique might reduce time and improve outcomes.

Thoracoscopic thymectomy using a subxiphoid camera port

I Sastre, M España, R Ceballos, M Bustos
15 days ago
Surgical intervention
Laparoscopic central pancreatectomy for renal cell carcinoma metastasis
Authors present the case of a laparoscopic central pancreatectomy in a patient with a clear cell renal cell carcinoma metastatic lesion to the pancreatic neck.
A 71-year old female patient was admitted with a pancreatic neck lesion detected by abdominal ultrasound performed for mild epigastric pain she has been suffering from for 3 months prior to admission. Her past medical history is significant for right nephrectomy performed 25 years ago. The patient stated that she had an acquired cystic kidney disease, but no medical records were available to confirm that. A multidisciplinary investigation was performed. Pancreatic protocol CT-scan revealed a 2.5cm hyper-enhancing round-shaped tumor, located within the pancreatic neck. The patient had no carcinoid syndrome, and levels of PNET specific markers (Chromogranin A, NSE, Insulin, 5-HIIA) were not elevated. CA 19-9 and CEA levels were also normal. The tumor was [111In]-octreotide negative on octreotide scan. As a result, a non-functioning pancreatic neuroendocrine tumor was suspected considering its CT-scan characteristics.
A laparoscopic pancreatic enucleation was planned with possible central pancreatectomy in case the enucleation would turn out to be unfeasible. The attempt to perform enucleation failed due to intensive bleeding from an intrapancreatic vessel, unclear borders of the tumor, and high risk of postoperative pancreatic fistula formation. It was decided to continue the surgery with central pancreatectomy.
The postoperative course was complicated by a postoperative pancreatic fistula (POPF) grade B (according to the ISGPF classification), which was managed successfully using interventional percutaneous drainage. Final histopathological examination revealed a clear cell renal cell carcinoma (RCC) metastatic lesion to the pancreas. A CT-scan performed 2 years after the surgery revealed no signs of disease progression. The pancreaticojejunostomy shows no signs of obstruction. The patient has neither exocrine nor endocrine pancreatic insufficiency.
The purpose of the video is to demonstrate the feasibility of laparoscopic central pancreatectomy, which is an organ-preserving procedure and is accompanied with better long-term results.

Laparoscopic central pancreatectomy for renal cell carcinoma metastasis

P Agami, M Baychorov, R Izrailov, I Khatkov
15 days ago
Surgical intervention
Laparoscopic Sugarbaker parastomal hernia repair
In this video, authors demonstrate a laparoscopic Sugarbaker technique for parastomal hernia repair using a Gore-Tex mesh in an 18-year-old man with a history of anal cancer status post-abdominoperineal resection with an end colostomy and known chronic parastomal hernia. His history also includes hypoplastic left heart syndrome status post-orthotopic cardiac transplant, DiGeorge syndrome, Hodgkin’s disease type post-transplant lymphoproliferative disease, and immune deficiency. He presented with abdominal pain, nausea, and vomiting secondary to small bowel obstruction at the site of his previous parastomal hernia. CT-scan showed a mesenteric swirl with a transition point. Upon laparoscopy, the parastomal hernia was identified. The bowel was reduced and hernia edges cauterized. Primary repair of the hernia defect was performed using a percutaneous technique. A Jackson-Pratt (JP) drain was left inside the hernia area and exited through a separate part of the abdomen. Following the Sugarbaker technique, a 16 by 20cm Gore-Tex dual mesh plus was used to reinforce the defect. Percutaneous sutures in the four corners secured the mesh. Once the mesh was in the desired location, absorbable tackers were used to attach the mesh to the anterior abdominal wall. Additional percutaneous sutures were added to the medial mesh. The patient recovered well. His nasogastric tube was removed on postoperative day (POD) 4. He was advanced to a regular diet and discharged on POD 7. Surveillance CT showed an intact repair with no recurrence a year after surgery. This case demonstrates a Sugarbaker technique for the closure of parastomal hernias using a Gore-Tex graft for parastomal hernias. The laparoscopic Sugarbaker technique is a safe procedure for the repair of parastomal hernias.

Laparoscopic Sugarbaker parastomal hernia repair

T Huy, A Bajinting, J Greenspon, GA Villalona
15 days ago
Complete mesocolic excision (CME)
In this key lecture, Dr. Armando Melani outlines complete mesocolic excision (CME).

Complete mesocolic excision (CME)

A Melani
15 days ago
Understanding the splenic flexure
In this authoritative lecture, Dr. Bill Heald provides key explanations to better understand the splenic flexure of the colon.

Understanding the splenic flexure

RJ Heald
15 days ago
Laparoscopic TME
In this key lecture, Dr. Masaaki Ito describes laparoscopic TME.

Laparoscopic TME

M Ito
15 days ago
Essential anatomy and steps in performing TaTME
In this key lecture, Dr. Mark Whiteford focuses on the essential anatomy and steps to perform transanal total mesorectal excision (TaTME).

Essential anatomy and steps in performing TaTME

M Whiteford
15 days ago
Laparoscopic treatment of peritonitis after low anterior resection (interactive case)
In this key lecture, Dr. Eric Rullier outlines the laparoscopic treatment of peritonitis after low anterior resection, providing an interactive case.

Laparoscopic treatment of peritonitis after low anterior resection (interactive case)

E Rullier
15 days ago

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